Medically reviewed content. Last updated: April 2026.
Medically reviewed content. Last updated: April 2026.
Perineal tearing during vaginal birth is common, affecting up to 85% of people. While the idea can be frightening, most tears are minor and heal well. This guide explains the different types of tears, what an episiotomy is, what you can do to reduce your risk, and how to recover comfortably.
The perineum is the area of skin and muscle between the vaginal opening and the anus. During a vaginal birth, this tissue stretches to allow your baby to pass through. Sometimes it stretches enough. Sometimes it tears.
Perineal tears are classified by severity:
First-degree tear. A small tear to the skin only. These often heal naturally without stitches and cause minimal discomfort.
Second-degree tear. A tear extending into the muscle beneath the skin. This is the most common type and usually requires stitches. Recovery takes a few weeks, and the stitches dissolve on their own.
Third-degree tear. A tear that extends into the muscle surrounding the anus (the anal sphincter). This occurs in around 3 to 4% of vaginal births and requires repair in an operating theatre under regional or general anaesthesia.
Fourth-degree tear. A tear that extends through the anal sphincter and into the lining of the rectum. This is rare and also requires surgical repair.
Third and fourth-degree tears are collectively known as obstetric anal sphincter injuries (OASI). With proper repair and follow-up, most people make a good recovery, though some may experience longer-term effects on bowel control.
An episiotomy is a deliberate cut made by a midwife or doctor in the perineum during birth. It is not routine in the UK and is only performed when there is a clinical reason, such as your baby showing signs of distress and needing to be born quickly, an instrumental delivery (forceps or ventouse) is needed, or there is a concern about a severe tear occurring.
The cut is made at an angle (medio-lateral episiotomy) and is repaired with dissolvable stitches after the placenta is delivered. You should be given local anaesthetic before the cut is made, and your consent should always be sought except in genuine emergencies.
NICE guidelines state that episiotomy should not be performed routinely and should only be done when clinically indicated.
While tearing cannot always be prevented, several evidence-based approaches can reduce the risk or severity.
Starting from around 34 weeks, massaging the perineum with a natural oil (such as almond or olive oil) for 5 to 10 minutes, a few times per week, can help prepare the tissue for stretching. A Cochrane review found that perineal massage from 34 weeks reduced the likelihood of perineal trauma requiring stitching, particularly in first-time births.
Your midwife can apply a warm, wet compress to your perineum during the pushing stage. Research shows this reduces the risk of third and fourth-degree tears.
Following your midwife's guidance during the pushing stage, particularly breathing the baby out slowly rather than pushing forcefully, allows the perineum to stretch more gradually. Your midwife may ask you to pant or blow during the final contractions to slow the delivery of the baby's head.
Giving birth in upright or side-lying positions (rather than lying on your back with legs in stirrups) is associated with reduced rates of episiotomy and severe tearing. Positions such as hands and knees, kneeling, standing, or side-lying give the pelvis more room to open.
Labouring and birthing in water may help the perineum stretch more gently due to the warmth and buoyancy of the water. Some studies show reduced rates of episiotomy and severe tearing with water birth.
First and second-degree tears are usually stitched by your midwife or doctor shortly after birth, using dissolvable stitches and local anaesthetic. The repair takes 10 to 30 minutes.
Third and fourth-degree tears are repaired in an operating theatre by an experienced obstetrician, usually under regional anaesthesia (a spinal or epidural). You will be given antibiotics to prevent infection and laxatives to make bowel movements more comfortable while you heal.
Paracetamol and ibuprofen are safe and effective for perineal pain, including while breastfeeding. Take them regularly rather than waiting until the pain becomes severe.
Pour warm water over the area when you wee to dilute the urine and reduce stinging. Pat the area dry rather than rubbing. Change maternity pads frequently. Avoid perfumed soaps or bath products near the area.
Sitting on a cushion or a folded towel can help. Some people find a ring-shaped cushion comfortable. Cold packs wrapped in a clean cloth and applied to the area for 10 to 15 minutes can reduce swelling in the first 24 to 48 hours.
Starting gentle pelvic floor exercises as soon as you feel able (even the day after birth) promotes blood flow to the area and supports healing. Begin with short holds and build up gradually.
The first bowel movement after stitches can feel daunting. Drinking plenty of water, eating high-fibre foods, and taking a gentle laxative (if offered) all help keep stools soft. Holding a clean pad against your perineum during a bowel movement can provide support and reassurance.
Dissolvable stitches typically dissolve within two to four weeks. You do not need them removed. If they feel tight, itchy, or uncomfortable, this usually indicates healing.
Contact your midwife or GP if:
If you had a third or fourth-degree tear, you should be offered a follow-up appointment with an obstetrician at around 6 to 12 weeks postpartum. This may include assessment of your anal sphincter function and a discussion about the implications for future births.
Most people with a well-repaired third-degree tear recover fully. Around 60 to 80% report no long-term symptoms. For those who do experience ongoing issues (such as faecal urgency or incontinence), physiotherapy and in some cases further surgery can help.
A previous OASI does not automatically mean you will need a caesarean next time. RCOG recommends that the decision about mode of delivery in future pregnancies be made on an individual basis, considering your recovery and symptoms.
The perineum is the area of skin and muscle between the vaginal opening and the anus. During a vaginal birth, this tissue stretches to allow your baby to pass through. Sometimes it stretches enough. Sometimes it tears.
Perineal tears are classified by severity:
An episiotomy is a deliberate cut made by a midwife or doctor in the perineum during birth. It is not routine in the UK and is only performed when there is a clinical reason, such as your baby showing signs of distress and needing to be born quickly, an instrumental delivery (forceps or ventouse) is needed, or there is a concern about a severe tear occurring.
While tearing cannot always be prevented, several evidence-based approaches can reduce the risk or severity.
First and second-degree tears are usually stitched by your midwife or doctor shortly after birth, using dissolvable stitches and local anaesthetic. The repair takes 10 to 30 minutes.
Contact your midwife or GP if:
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